Date posted:
Attachment(s):
Notice of MaineCare Reimbursement Methodology Change
AGENCY: Department of Health and Human Services, Office of MaineCare Services
SERVICES INCLUDED: Chapter 101, MaineCare Benefits Manual, Section 65, Behavioral Health Services
NATURE OF PROPOSED CHANGES: The Department plans to begin reimbursing the following effective January 30, 2026:
|
Description |
Procedure Code |
Modifier |
Unit |
Rate |
|
Substance Use – Level II |
H0015 |
CG |
Per Diem |
$286.23 |
REASON FOR PROPOSED CHANGES: All changes are pursuant to the DOJ Settlement Agreement, United States v. State of Maine, No. 1:24-cv-00315-SDN (D. Me. Dec. 20, 2024) (Order on Mot. Dismiss and Retain Jurisdiction, Ex. A, Settlement Agreement Between the United States of America and the State of Maine.)
ESTIMATE OF ANY EXPECTED INCREASE OR DECREASE IN ANNUAL AGGREGATE EXPENDITURES: The Department anticipates that this change will cost $592,467 in federal fiscal year 2026 which includes $476,068 in federal funds and $116,399 in state funds, and will cost $789,956 in federal fiscal year 2027 which includes $632,819 in federal funds and $157,137 in state funds.
ACCESS TO PROPOSED CHANGES AND COMMENTS TO PROPOSED CHANGES: The public may review the proposed methodology changes and written comments at any Maine DHHS office in every Maine county. To find out where the Maine DHHS offices are located, call 1-800-452-1926.
CONTACT INFORMATION
FOR RECEIPT OF COMMENTS: Kristin Merrill
AGENCY NAME: Office of MaineCare Services
ADDRESS: 109 Capitol Street, 11 State House Station
Augusta, Maine 04333-0011
TELEPHONE: (207) 624-4006 FAX: (207) 287-6106
TTY: 711 Maine Relay (Deaf or Hard of Hearing)
See http://www.maine.gov/dhhs/oms/rules/index.shtml for rules and related rulemaking documents.
State Plan Amendment
Office: MaineCare Services
Email: Kristin.Merrill@maine.gov
Comment deadline:
On